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1 January 2012, Vol. 15, No. 1 (Pages 1-8)2012 Call us: 1-877-912-1691 The coding Institute LLC, 2222 Sedwick Drive, Durham, NC 27713 pediatric coding AlertYour practical adviser for ethically optimizing coding , payment, and efficiency in pediatric practicesThe coding Institute SPECIALTY ; Inspired by Coders, Powered by coding ExpertsIn this issueICD-10 Scroll to Section When coding Jaundice After ICD-10 Takes Effect p3 Note: Medicaid contractors are working to meet ICD-10 Err Is Human But You Can Correct Medical Records If You Follow These 5 Tips p4 You can make medical records accurate even after the visit, as long as the practitioner heeds essential compliance Be the Coder p4 Determine Whether 99058 is Justified Reader QuestionsTurn to 90460 for FluMist p6 Consider for Developmental Screening p6 Know How Many Vitals Total 1 Exam Bullet p6 Many Insurers Still Accept Consult Codes p7 CPT 2012 } pediatric Hospital Rounds Will Be Easier to Code, Thanks to CPT Clarifications Differentiate the four common types of pediatric hospital visits and you ll be on the road to correct most pediatricians evaluate newborn inpatients as part of their regular weekly work, some practices struggle with how to code these services.

2 But once you break it down into the four most common categories of inpatient E/M rounds, you could be sending claims out the door faster and more NICU Changes for 2012 Two of the most serious types of infant hospital visits involve time with intensive care or critical care. In both of these cases, the pediatrician has to go above and beyond what s required when seeing a healthy newborn and coding these visits can be a issue of level of care provided is not specific to the site of service. However, neonatal critical and intensive care services are typically provided in a care: Suppose a baby is tachypneic with a fever as a newborn and is worked up and treated for sepsis. The pediatrician provides a neonatal intensive level of care, performing daily intensive care services. In these situations you ll report a code from the 99477-99480 series of CPT .Critical care: When the pediatrician sees a patient for more severe issues such as organ system failure or severe respiratory distress he might determine that the patient is in need of critical care, which you ll code using the 99468-99469 series.

3 In many cases, critical care would be managed by a for 2012: In the past, if a patient was transferred from neonatal intensive to critical care or vice versa the coding rules were unclear. However, CPT 2012 cleans up that issue with parenthetical notes to guide you in making the correct code AMA s CPT Changes 2012 states, New introductory language has been added to the inpatient neonatal intensive care services and pediatric and neonatal critical care service guidelines preceding code 99477 pertaining to the circumstance when the transfer of care of a sick neonate receiving intensive care services occurs from one physician to another physician in a different group, in which both providers will be providing intensive care services on the same date of service. The coding Institute SPECIALTY ALERTSCall us: 1-877-912-1691 The coding Institute LLC, 2222 Sedwick Drive, Durham, NC 27713p2 SPECIALTY specific codesets, tools and content on one page in Call 1-866-228-9252 now for a super deal!

4 Single User Copy : Not allowed for more than one user without Publisher ApprovalEditorial advisory Board Suzan Berman, CPC, CEMC, CEDCM anager- coding and Compliance UPMC-UPP Department of SurgeryNancy Bishof, MDPracticing Pediatrician Lexington, Callender, PhD(c), CPNPP ediatric Nurse Practitioner Stafford Pediatrics, P. Crow, MDTrauma Medical Director, CHMCA Attending pediatric Surgeon, CHMCA Attending Burn Surgeon, Clifford Boeckman Regional Burn Center CPT adviser, American pediatric Surgical AssociationMary I. Falbo, MBA, CPCP resident, Millennium Healthcare Consulting Holle, RNPresident, , Ft. Wayne, Ind. Past Director of Professional Services University of Michigan, Dept. of Pediatrics Victoria S. Jackson Practice Management Consultant, JCM Inc. Former Administrator/CEO, Southern Orange County pediatric Associates Inc., Calif. Member, Medical Group Management Association Primary Care AssemblyAlbert D. Jacobson, MD, CPAM edical Director, pediatric Associates, D.

5 KortanekAdministrator, Northpoint Pediatrics, Lander, MD, FAAPM edical Director, Essex-Morris pediatric Group in New JerseyJanet McDiarmid, CPC,MPC,CMM,CCPC oding Analyst, St. Petersburg Pediatrics, Fla. CEO, McDiarmid Consultants LLC Past President, AAPC National Advisory BoardDebra Pierce, MD, MBA, CPCP ierce MD Consulting, LLC Rockbridge, OhioPeter Rappo, MD, FAAPA ssistant Clinical Professor of Pediatrics Harvard University, J. A. Schulte III, MD, FAAPP racticing Pediatrician, Countryside Pediatrics, A. Scott, MD, FAAPP racticing Office-Based Pediatrician Medford pediatric and Adolescent Medicine, H. StephensonPresident, North Shore Central Medical Management, OhioRichard H. Tuck, MD, FAAPF ounding Member, AMA RBRVS RUC Practice Pediatrician, PrimeCare of Southeastern Ohio What CPT now clarifies is that if an infant improves after the initial day and is transferred to a lower level of care, the transferring physician does not report a per-day intensive care service.

6 Instead, the transferring doctor will report a code from the subsequent hospital care section (99231-99233) of CPT . The receiving physician will report subsequent intensive care (99478-99480) or subsequent hospital care (99231-99233) as appropriate based on the condition of the neonate or child, CPT the physician delivers intensive care services but the patient becomes critically ill and is transferred to a different physician, the transferring physician reports either the critical hourly care service (99291-99292) or the daily intensive care service performed, but not both, CPT says. The receiving physician reports subsequent inpatient neonatal or pediatric critical care (99469, 99472). It s now very clear that when the admission to the hospital and the unit are the same day, it s always the initial code, said Peter A. Hollmann, MD, chair of the CPT Editorial Panel, during the CPT 2012 Annual Symposium in Chicago on Nov.

7 16. The new rules make it clear when admission is from intensive care to critical care, the receiving physician will use a subsequent day critical care code. Healthy Patient? Look to Well Care (99460-99463)Fortunately, most newborns that pediatricians typically see in practice are healthy, and those services can be coded by selecting from the 99460-99463 series, which represent standard normal newborn per-day normal newborn has no medical conditions or need for special care. Report a normal newborn s history and examination with 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant).This code includes a maternal and/or fetal and newborn history, a newborn physical examination, meeting with the family, documentation in the record, and ordering any diagnostic tests or most cases, you ll report x (Single liveborn) as your diagnosis code in these instances. Add-ons: Procedures such as circumcision (54150, Circumcision, using clamp or other device with regional dorsal penile or ring block or 54160, Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate [28 days of age or less]) are not included with the normal newborn codes.

8 Be sure to code the circumcision in addition to the newborn care. To indicate 99460-99463 is separately identifiable from the minor E/M included in surgical codes, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). pediatric coding alert (USPS 016-894) (ISSN 1098-1799 for print; ISSN 1947-6817 for online) is published monthly 12 times per year by The coding Institute LLC, 2222 Sedwick Drive, Durham, NC 27713. 2012 The coding Institute. All rights reserved. Subscription price is $249. Periodicals postage is paid at Durham, NC 27705 and additional entry : Send address changes to pediatric coding alert , 2222 Sedwick Drive, Durham, NC 27713 Call us: 1-877-912-1691 The coding Institute LLC, 2222 Sedwick Drive, Durham, NC 27713 The coding Institute SPECIALTY ALERTSS pecialty specific codesets, tools and content on one page in Call 1-866-228-9252 now for a super deal!

9 P3 Single User Copy : Not allowed for more than one user without Publisher Approval Stable Sick Patients May Require 99231-99233In some cases, a patient is in good health overall, but has some underlying issues that the physician has to spend more time evaluating. For instance, a newborn patient has jaundice that requires therapy. In these cases, you ll select the appropriate code from the 99231-99233 series, as supported by the pediatrician s documentation. The codes in this series are not pediatric -specific, but can be billed for newborn services. qIf you re like most pediatric staffers, you ve got the unspecified jaundice code memorized. However, that code will be but a memory when ICD-10 takes effect on Oct. 1, 2013. Take a look at how your jaundice coding will change in less than two is a condition caused by a buildup of bilirubin in a patient s blood, and in newborns, it most commonly occurs within the first few days after birth.

10 The condition causes a yellowish hue to the skin and typically resolves on its own, but in some cases, requires further way: Under ICD-9 rules, you have just one code for unspecified neonatal jaundice, You report this code unless the physician identifies a cause for the jaundice (such as being due to breast milk inhibitors, which would be ). In the majority of cases, however, infants cases of jaundice are unspecified in nature and you code them with Changes: When the ICD-10 transition takes place, you will fortunately benefit from a one-to-one transition for your unspecified jaundice cases and you ll turn to (Neonatal jaundice, unspecified) when the physician documents that a patient has jaundice that isn t due to any specific cause. If a cause is identified in the notes, you d report that instead. For instance, if the patient s jaundice is due to breast milk inhibitor, under ICD-10 you d report However, most jaundice cases fit into the unspecified : As in the past, physicians have needed to document whether a patient s jaundice is caused by a more specific condition, but if the pediatrician simply documents neonatal jaundice, will be your best option.